Quotation Estimate Orthodontist in Nepal Kathmandu –Free Word Template Download with AI
| Field | Details |
|---|---|
| Patient Name | [Full Name of Patient] |
| Age / Gender | [Age] / [Gender] |
| Contact Number | [Phone Number] |
| Address | [Residential Address], Kathmandu, Nepal |
| Referring Physician | [Name, if applicable] |
This Quotation Estimate is issued by the undersigned Orthodontist practising in Nepal Kathmandu and outlines the comprehensive orthodontic treatment plan, associated procedures, and estimated costs for the patient identified above. All services will be delivered at the Kathmandu Smile Orthodontic Centre, New Baneshwor, Kathmandu, Nepal, in accordance with the standards set by the Nepal Medical Council and the Nepal Orthodontic Society.
3. Itemised Treatment Plan & Cost Breakdown| # | Service / Procedure | Frequency | Duration | Estimated Cost (NPR) |
|---|---|---|---|---|
| 1 | Initial Consultation & Diagnostic Records (Panoramic X-ray, Cephalometric X-ray, Intraoral Photographs, Digital Impressions) | One-time | 1 session | Rs. 8,500 |
| 2 | Comprehensive Treatment Planning & Digital Smile Design | One-time | 1 session | Rs. 5,000 |
| 3 | Placement of Fixed Metal Braces (Full Arch — Upper & Lower) | One-time | 1 session | Rs. 65,000 |
| 4 | Monthly Orthodontist Adjustment & Wire Changes | Monthly | 18 months | Rs. 3,500 × 18 = Rs. 63,000 |
| 5 | Interproximal Reduction (IPR) & Elastics (if required) | As needed | During treatment | Rs. 12,000 |
| 6 | Removal of Braces & Bonding of Fixed Retainers (Upper & Lower) | One-time | 1 session | Rs. 15,000 |
| 7 | Removable Retainers (Hawley Type — Upper & Lower) | One-time | — | Rs. 10,000 |
| 8 | Post-Treatment Follow-Up Visits (Orthodontist Review) | Every 6 months | 2 years | Rs. 2,000 × 4 = Rs. 8,000 |
| 9 | Emergency / Breakage Repair (estimated allowance) | As needed | During treatment | Rs. 5,000 |
| TOTAL ESTIMATED COST (NPR) | Rs. 191,500 | |||
| VAT (13% as per Nepal Government Tax Regulations) | Rs. 24,895 | |||
| GRAND TOTAL (NPR) | Rs. 216,395 | |||
| Milestone | Amount (NPR) | Due Date |
|---|---|---|
| Advance Payment (upon acceptance of this Quotation Estimate) | Rs. 50,000 | Within 7 days of signing |
| Brace Placement (at the time of appliance bonding) | Rs. 70,000 | At placement session |
| Monthly Adjustments (billed per visit) | Rs. 3,500 / month | Each monthly visit |
| Final Balance (retainers, follow-ups, VAT, and any additional procedures) | Rs. 96,395 | At debonding / completion |
- This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. After the expiry date, the Orthodontist reserves the right to revise pricing due to changes in material costs, import duties, or regulatory updates within Nepal Kathmandu.
- All costs are quoted in Nepalese Rupees (NPR). International patients may pay in USD or EUR at the prevailing Nepal Rastra Bank exchange rate on the day of transaction.
- The treatment duration of approximately 18 months is an estimate. The treating Orthodontist may adjust the timeline based on individual patient response, compliance with elastics, and any unforeseen clinical developments.
- Missed appointments beyond 48 hours without prior rescheduling may incur a no-show fee of Rs. 1,500 per occurrence.
- This Quotation Estimate does not include the cost of extractions, periodontal treatment, or restorative dentistry unless explicitly stated. Any additional procedures will be communicated and separately quoted by the Orthodontist before commencement.
- The patient agrees to maintain proper oral hygiene and attend all scheduled adjustment appointments at the Kathmandu Smile Orthodontic Centre, New Baneshwor, Kathmandu, Nepal.
- In the event of appliance breakage due to patient negligence (e.g., biting hard objects), repair costs will be charged separately at the standard clinic rate.
- All diagnostic records, digital scans, and treatment files remain the property of the clinic. The patient may request a copy for a second opinion at a nominal reproduction fee.
- This Quotation Estimate is subject to the medical and ethical guidelines of the Nepal Medical Council and the Nepal Orthodontic Society. Disputes, if any, shall be resolved through amicable negotiation or the competent court in Kathmandu, Nepal.
By signing below, the patient (or legal guardian) acknowledges having received and reviewed this Quotation Estimate for Orthodontist services in Nepal Kathmandu, understands the scope of treatment, associated costs, and terms outlined herein, and authorises the commencement of the described orthodontic care plan.
For the Orthodontist / Clinic
Dr. Anisha Shrestha, BDS, MDS (Orthodontics)
Kathmandu Smile Orthodontic Centre
Signature & DatePatient / Legal Guardian
Name: ___________________________
Relationship: ____________________
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